Leveraging Data Drives Revenue
We turn complex healthcare data into actionable and meaningful insight to improve population health and increase revenue. Whether it's identifying timely clinical interventions that focus on reducing downstream healthcare costs or improving reporting measures as part of shared savings agreements, competing for analytic success is now a crucial component any healthcare organization. We believe in insights that are clinically focused and business-specific that follow sound epidemiologic methodology.
maximize cms reimbursements
CMS (Medicare) reimburses some health plans based on the "risk" of the beneficiaries enrolled. The HCC payment methodology is used to adjust payments up or down. We wrote a computer program leveraging natural language processing (NLP) to search through over 100,000 medical text documents leading to additional payments to the plan that were being missed by billing data alone.
change prescribing patterns to increase margins
"Preferred Brand" drugs are identified as generally having no generic equivalent, and are either more effective than other drugs in the same class or are equally effective but less costly than the other drugs. We built an interface to identify physician opportunities to move their patients from non-preferred to preferred brand drugs, leading to savings of over 2 million dollars for a small health plan.
leverage adherence to improve cms star ratings
Some Medicare Advantage healthcare plans receive bonus payments based on quality ratings related to performance. Under the measurement domain, "Drug Safety and Accuracy of Drug Pricing" are several measures related to medication adherence. Calculating each patient's adherence (proportion of days covered) to each drug measure on a monthly basis identifies opportunities to convert patients from a low score to a high score, which targets the appropriate interventions to drive an improved CMS star rating.